Provider Demographics
NPI:1609063585
Name:FRIED, SCOTT MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MARTIN
Last Name:FRIED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1515 DEKALB PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422
Mailing Address - Country:US
Mailing Address - Phone:610-277-1990
Mailing Address - Fax:610-277-2007
Practice Address - Street 1:1515 DEKALB PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3367
Practice Address - Country:US
Practice Address - Phone:610-277-1990
Practice Address - Fax:610-277-2007
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-004983-L207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD98801Medicare UPIN
PA475199Medicare PIN